Generation Z presents new challenges for medical education

Students now entering university education belong to so-called Generation Z. This generation has qualities such as good problem-solving and practical skills, a high level of proficiency in the use of digital tools and a success-oriented attitude. At the same time, though, compared with previous generations, many of them are more emotionally unstable, more prone to failure and, according to studies, more likely to suffer from mental disorders.

So effective training of Generation Z requires new approaches in medical education.

Who is in Generation Z?

Generation Z – those born between 1995 and 2010 and often referred to as the “Facebook” or “net” generation – has many characteristics in addition to (or as a result of) their constant use of the internet. Despite this cohort’s diversity, a higher frequency of certain psychological features can be detected in its members compared with previous generations. Among these are their well-developed problem-solving skills, highly practical thinking and good sense of technology. They also have good abstraction skills, are better at dividing their attention and more tolerant of increasing environmental stimuli, and can keep up with rapid technological change. All these factors can make them appear smarter than previous generations.

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On the other side of the coin, members of Generation Z are generally slower to comprehend long single-paragraph texts, feel lonely or alienated from their environment more often than others, repeatedly have problems meeting the expectations of others (and themselves), are failure-prone (and therefore often failure-averse), favour quick experiences and rapid success, and have difficulty in managing interpersonal conflicts. This can lead to a higher risk of mental health issues; a British study, for example, shows a five-fold increase in the number of mental disorders among university students between 2007 and 2018.

Generation Z and the stress of medical education

Unfortunately, the mentioned figures are even worse among students of medical schools. According to a review study published in JAMA, depression affects about a quarter of medical students and their suicide risk is around 11 per cent. They can also be characterised by a higher frequency of anxiety, sleep and attention-deficit disorders.

The reasons can only be speculated upon and might be subject to future investigations. The first possible explanation is the discrepancy in desires, unrealistic life goals and their realistic fulfilment. In this generation, the need for fast and outstanding financial, social and personal success (that is, getting rich, becoming famous or very successful socially in a very short time) is common, even if this cannot be achieved by most people. Therefore, sooner or later, those who pursue these unrealistic goals become frustrated.

Second, they spend a great deal of time in virtual communities, which does not help them to develop emotion regulation or face-to-face conflict-management skills and assertiveness.

Third, many Gen Z-ers experience a sense of total uncertainty about the future (for example, around climate change, the possibility of pandemics, global terrorism and unpredictability due to rapid change) alongside a desire for rapid success. The need to succeed combined with an unpredictable and uncertain future is a sure recipe for anxiety.

At the same time, and importantly, members of Generation Z are endowed with all the qualities needed to become excellent practitioners: they are motivated, practical and problem-solving, have a strong helping attitude and are sensitive to human problems.

How can we make medical education work for Gen Z?

The question then is how can we make education more attractive and more effective for Generation Z? A short answer is that we can respond to their preferences: we can increase the use of digital tools in education or tailor our training tools to the needs and abilities of this generation. We can also support them to develop real-life personal skills, place more emphasis on real-life situations and provide a wider range of experience-based training courses in higher education.

In practical terms, this could mean we offer:

Digital toolkits in education

Digital education should be based on the “online publishing house”. This is where notes, exam preparation tests, curiosities and gamified tutorials are uploaded. Another important element could be a collection of mobile-phone applications to support learning. Through digital walkthroughs or situational exercises, highly practical skills can be built up in the virtual space.

Experience-based training in real-life situations

Medicine is a practical profession, and doctors often encounter their patients in very emotional situations. Students cannot learn to deal with these situations only in virtual reality, nor can they develop in such simulated situations the manual skills that are essential if they are to approach another (possibly anxious or disturbed) person in a proper way by making physical contact. They need to acquire the skills both to be empathic with their patients and to manage their own emotions. These complex sets of behaviour can be acquired only through a series of real-life situations, with careful guidance and mentoring. Face-to-face education has never been as important as it is today, in a time of virtual realities.

Visual structuring of learning material

Because young people often have difficulties with text comprehension and experience “visual hunger”, the most effective way to address them is through infographics and the rigorous visual structuring of learning material. This is a challenging but rewarding task for large course materials, because it increases student satisfaction and gives them more visible clues to the importance and context of the information. For theoretical subjects, it is worth highlighting the practical relevance of a course from the perspective of future clinical work (we should not forget that most students are training to be practising doctors).

Reorientate courses from failure-fear and rivalry to success and curriculum integrity

Exams are an important motivating factor, but exam nerves that last throughout the semester are not conducive to effective learning nor to the appreciation of the subject. Instead of abandoning students after exam failure, it is important to teach them how to cope with such difficulties. Explicit, measurable and transparent exam requirements are also important to reduce students’ fear.

The information overload of students results in unhealthy rivalry among university courses in the students’ mind. If they need to prioritise courses due to overwhelming expectations, it hampers the integration of the material into comprehensive, applicable, practical professional knowledge. Prioritisation among departments and institutions leads to a splintered set of courses and prevents curriculum integrity – which should be an important ultimate outcome of university education.

The importance of community building and extracurricular student support

In addition to education, extracurricular activities and other socialisation programmes are essential for student support. But perhaps even more important than social activities is helping students adjust to university life and cope with its difficulties. The most effective way of doing so is through peer-support programmes, where well-trained upper-year students share their knowledge and experience with first-year students and provide practical help in solving high-stress problems. There is a long tradition of peer support at Semmelweis University, where students can participate in a variety of programmes (for instance, mentoring or psychological support). Beside mentoring, curricular and extracurricular skill development programmes and easily accessible student counselling are equally important for responding to the needs of our students and provide them with a truly comprehensive educational programme.

György Purebl is director of the Institute of Behavioural Sciences at Semmelweis University, Budapest, Hungary.

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If you’re having suicidal thoughts or feel you need to talk to someone, a free helpline is available around the clock in the UK on 116123, or you can email jo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.